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De Ridder F, Charleer S, Jacobs S, Bolsens N, Ledeganck KJ, Van Aken S, Vanbesien J, Gies I, Casteels K, Massa G, Lysy PA, Logghe K, Lebrethon MC, Depoorter S, Gillard P, De Block C, den Brinker M. Effect of nationwide reimbursement of real-time continuous glucose monitoring on HbA1c, hypoglycemia and quality of life in a pediatric type 1 diabetes population: The RESCUE-pediatrics study. Front Pediatr 2022; 10:991633. [PMID: 36275049 PMCID: PMC9582657 DOI: 10.3389/fped.2022.991633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Real-time continuous glucose monitoring (RT-CGM) can improve metabolic control and quality of life (QoL), but long-term real-world data in children with type 1 diabetes (T1D) are scarce. Over a period of 24 months, we assessed the impact of RT-CGM reimbursement on glycemic control and QoL in children/adolescents with T1D treated with insulin pumps. RESEARCH DESIGN AND METHODS We conducted a multicenter prospective observational study. Primary endpoint was the change in HbA1c. Secondary endpoints included change in time in hypoglycemia, QoL, hospitalizations for hypoglycemia and/or ketoacidosis and absenteeism (school for children, work for parents). RESULTS Between December 2014 and February 2019, 75 children/adolescents were followed for 12 (n = 62) and 24 months (n = 50). Baseline HbA1c was 7.2 ± 0.7% (55 ± 8mmol/mol) compared to 7.1 ± 0.8% (54 ± 9mmol/mol) at 24 months (p = 1.0). Participants with a baseline HbA1c ≥ 7.5% (n = 27, mean 8.0 ± 0.3%; 64 ± 3mmol/mol) showed an improvement at 4 months (7.6 ± 0.7%; 60 ± 8mmol/mol; p = 0.009) and at 8 months (7.5 ± 0.6%; 58 ± 7mmol/mol; p = 0.006), but not anymore thereafter (endpoint 24 months: 7.7 ± 0.9%; 61 ± 10mmol/mol; p = 0.2). Time in hypoglycemia did not change over time. QoL for parents and children remained stable. Need for assistance by ambulance due to hypoglycemia reduced from 8 to zero times per 100 patient-years (p = 0.02) and work absenteeism for parents decreased from 411 to 214 days per 100 patient-years (p = 0.03), after 24 months. CONCLUSION RT-CGM in pump-treated children/adolescents with T1D showed a temporary improvement in HbA1c in participants with a baseline HbA1c ≥ 7.5%, without increasing time in hypoglycemia. QoL was not affected. Importantly, RT-CGM reduced the need for assistance by ambulance due to hypoglycemia and reduced work absenteeism for parents after 24 months. CLINICAL TRIAL REGISTRATION [ClinicalTrials.gov], identifier [NCT02601729].
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Affiliation(s)
- Francesca De Ridder
- Laboratory of Experimental Medicine and Pediatrics (LEMP) and Member of the Infla-Med Center of Excellence, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.,Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital (UZA), Antwerp, Belgium.,Fund for Scientific Research (FWO), Brussels, Belgium
| | - Sara Charleer
- Department of Endocrinology, University Hospitals Leuven, Catholic University of Leuven (KU Leuven), Leuven, Belgium
| | - Seppe Jacobs
- Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Nancy Bolsens
- Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Kristien J Ledeganck
- Laboratory of Experimental Medicine and Pediatrics (LEMP) and Member of the Infla-Med Center of Excellence, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Sara Van Aken
- Department of Pediatrics, University Hospital Ghent, Ghent, Belgium
| | - Jesse Vanbesien
- Department of Pediatrics, University Hospital Brussels, Free University of Brussels (VUB), Brussels, Belgium
| | - Inge Gies
- Department of Pediatrics, University Hospital Brussels, Free University of Brussels (VUB), Brussels, Belgium
| | - Kristina Casteels
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Guy Massa
- Department of Pediatrics, Jessa Hospital, Hasselt, Belgium
| | - Philippe A Lysy
- Department of Pediatrics, University Hospital Saint-Luc, Brussels, Belgium
| | - Karl Logghe
- Department of Pediatrics, General Hospital Delta, Roeselare, Belgium
| | | | - Sylvia Depoorter
- Department of Pediatrics, General Hospital Sint-Jan Bruges, Bruges, Belgium
| | - Pieter Gillard
- Fund for Scientific Research (FWO), Brussels, Belgium.,Department of Endocrinology, University Hospitals Leuven, Catholic University of Leuven (KU Leuven), Leuven, Belgium
| | - Christophe De Block
- Laboratory of Experimental Medicine and Pediatrics (LEMP) and Member of the Infla-Med Center of Excellence, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.,Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Marieke den Brinker
- Laboratory of Experimental Medicine and Pediatrics (LEMP) and Member of the Infla-Med Center of Excellence, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.,Department of Pediatrics, Antwerp University Hospital (UZA), Antwerp, Belgium
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Furthner D, Lukas A, Schneider AM, Mörwald K, Maruszczak K, Gombos P, Gomahr J, Steigleder-Schweiger C, Weghuber D, Pixner T. The Role of Protein and Fat Intake on Insulin Therapy in Glycaemic Control of Paediatric Type 1 Diabetes: A Systematic Review and Research Gaps. Nutrients 2021; 13:nu13103558. [PMID: 34684559 PMCID: PMC8537759 DOI: 10.3390/nu13103558] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/02/2021] [Accepted: 10/05/2021] [Indexed: 11/16/2022] Open
Abstract
Carbohydrate counting (CHC) is the established form of calculating bolus insulin for meals in children with type 1 diabetes (T1DM). With the widespread use of continuous glucose monitoring (CGM) observation time has become gapless. Recently, the impact of fat, protein and not only carbohydrates on prolonged postprandial hyperglycaemia have become more evident to patients and health-care professionals alike. However, there is no unified recommendation on how to calculate and best administer additional bolus insulin for these two macronutrients. The aim of this review is to investigate: the scientific evidence of how dietary fat and protein influence postprandial glucose levels; current recommendations on the adjustment of bolus insulin; and algorithms for insulin application in children with T1DM. A PubMed search for all articles addressing the role of fat and protein in paediatric (sub-)populations (<18 years old) and a mixed age population (paediatric and adult) with T1DM published in the last 10 years was performed. Conclusion: Only a small number of studies with a very low number of participants and high degree of heterogeneity was identified. While all studies concluded that additional bolus insulin for (high) fat and (high) protein is necessary, no consensus on when dietary fat and/or protein should be taken into calculation and no unified algorithm for insulin therapy in this context exists. A prolonged postprandial observation time is necessary to improve individual metabolic control. Further studies focusing on a stratified paediatric population to create a safe and effective algorithm, taking fat and protein into account, are necessary.
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Affiliation(s)
- Dieter Furthner
- Department of Paediatric and Adolescent Medicine, Salzkammergutklinikum Voecklabruck, 4840 Voecklabruck, Austria; (D.F.); (A.L.); (T.P.)
- Obesity Research Unit, Paracelsus Medical University, 5020 Salzburg, Austria; (A.M.S.); (K.M.); (K.M.); (J.G.)
| | - Andreas Lukas
- Department of Paediatric and Adolescent Medicine, Salzkammergutklinikum Voecklabruck, 4840 Voecklabruck, Austria; (D.F.); (A.L.); (T.P.)
- Obesity Research Unit, Paracelsus Medical University, 5020 Salzburg, Austria; (A.M.S.); (K.M.); (K.M.); (J.G.)
| | - Anna Maria Schneider
- Obesity Research Unit, Paracelsus Medical University, 5020 Salzburg, Austria; (A.M.S.); (K.M.); (K.M.); (J.G.)
- Department of Paediatrics, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Katharina Mörwald
- Obesity Research Unit, Paracelsus Medical University, 5020 Salzburg, Austria; (A.M.S.); (K.M.); (K.M.); (J.G.)
- Department of Paediatrics, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Katharina Maruszczak
- Obesity Research Unit, Paracelsus Medical University, 5020 Salzburg, Austria; (A.M.S.); (K.M.); (K.M.); (J.G.)
- Department of Paediatrics, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Petra Gombos
- Department of Paediatric and Adolescent Surgery, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Julian Gomahr
- Obesity Research Unit, Paracelsus Medical University, 5020 Salzburg, Austria; (A.M.S.); (K.M.); (K.M.); (J.G.)
- Department of Paediatrics, Paracelsus Medical University, 5020 Salzburg, Austria;
| | | | - Daniel Weghuber
- Obesity Research Unit, Paracelsus Medical University, 5020 Salzburg, Austria; (A.M.S.); (K.M.); (K.M.); (J.G.)
- Department of Paediatrics, Paracelsus Medical University, 5020 Salzburg, Austria;
- Correspondence: ; Tel.: +43-(0)-5-7255-57518
| | - Thomas Pixner
- Department of Paediatric and Adolescent Medicine, Salzkammergutklinikum Voecklabruck, 4840 Voecklabruck, Austria; (D.F.); (A.L.); (T.P.)
- Obesity Research Unit, Paracelsus Medical University, 5020 Salzburg, Austria; (A.M.S.); (K.M.); (K.M.); (J.G.)
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